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To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity ([greater than or equal to] 2 comorbidities) and depressive symptoms. Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). 127 older adults ([greater than or equal to] 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended.

Background Individuals face multifaceted barriers to accessing community resources, which can significantly impact their ability to obtain necessary support and services. This study examines barriers and enablers to access community resources among primary care patients and explores the interplay between individual- and system-level factors that influence access to resources. Methods In this qualitative study, we conducted 32 semi-structured interviews with primary care patients who participated in a social prescribing trial that compared two navigation services: ARC (patient-centered longitudinal support) vs. Ontario-211 (free 24-hour helpline service) in two regions, Ottawa and Sudbury, in the province of Ontario, Canada. We conducted thematic data analysis with a deductive/inductive hybrid approach, employing Levesque’s theoretical framework for access to health that examines the various system and individual level factors influencing access to healthcare services. Findings At the system level, various systemic barriers encompassing broader organisational, structural, and policy-related elements influenced patients' access to community resources (outreach, availability, location, costs and accommodations for patient needs and preferences). These factors directly interacted with various patient-level factors (awareness of needs, ability to seek support, to reach resources and to pay for those, their physical and mental health, motivation, and confidence to engage in care) to determine access. Conclusions Our findings highlight individual- and system-level barriers and enablers for accessing community resources among socially complex primary care patients with multiple unmet needs. As governments and organizations in Canada are increasingly investing in community-based services to address adverse social determinants of health (SDH), an upstream approach that reduces both systemic and individual-level barriers to access is warranted. Trial registration ClinicalTrials.gov Identifier NCT03451552 registration date 15th Dec 2017.

Background The COVID-19 pandemic disproportionately affected frail individuals, especially those living in long-term care (LTC) homes. This study examined the role of linguistic factors on COVID-19 related outcomes in LTC homes. Methods We performed a population-based, retrospective cohort study of residents living in LTC homes in Ontario, Canada who were diagnosed with COVID-19 between March 31, 2020 and March 31, 2021. Resident language, obtained from LTC assessments, was used to classify residents into one of the three linguistic groups: Anglophone (English), Francophone (French), and allophone (other language). Language of the LTC home was determined using a person-time representation of the languages spoken by residents within each LTC home. We defined LTC facilities as French homes when Francophone residents contributed more than 25% of the person-days, and allophone homes when allophone residents contributed more than 50% of the person-days. Residents whose language corresponded to the language of the LTC home in which they were living were said to have received language-concordant care , while all other residents were said to have received language-discordant care. The outcomes of this study were ED visits, hospitalizations, and mortality within 90 days. Results We included a total of 26,829 LTC residents (20,315 Anglophones, 1,032 Francophones, and 5,482 allophones) living in 572 LTC homes (502 English, 28 French, 42 allophone) who were diagnosed with COVID-19. LTC residents who lived in language-discordant homes were more likely to have ED visits (adjusted HR 1.12, 95% CI 1.01–1.25) and hospitalizations (adjusted HR 1.15, 95% CI 1.02–1.29) when compared to LTC residents who lived in language-concordant homes. Residents-facility language discordance was not associated with overall mortality (adjusted HR 1.00, 95% CI 0.91–1.10) or in hospital mortality (adjusted HR 1.04, 95% CI 0.88–1.23). Conclusion Residents living in language-discordant LTC facilities experienced more ED visits and hospitalizations following diagnosis of COVID-19. The findings of this study highlight the importance of providing frail, vulnerable individuals with linguistically concordant care.

Background Older adults ( > 65 years) with multiple chronic conditions (MCC) and depressive symptoms experience frequent transitions between hospital and home. Care transitions for this population are often poorly coordinated and fragmented, resulting in increased readmission rates, adverse medical events, decreased patient satisfaction and safety, and increased caregiver burden. There is a dearth of evidence on best practices in the provision of transitional care for older adults with MCC and depressive symptoms transitioning from hospital-to-home. This paper presents a protocol for a two-armed, multi-site pragmatic effectiveness-implementation trial of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led six-month intervention that supports older adults with MCC and depressive symptoms transitioning from hospital-to-home. The Collaborative Intervention Planning Framework is being used to engage patients and other key stakeholders in the implementation and evaluation of the intervention and planning for intervention scale-up to other communities. Methods Participants will be considered eligible if they are >  65 years, planned for discharged from hospital to the community in three Ontario locations, self-report at least two chronic conditions, and screen positive for depressive symptoms. A total of 216 eligible and consenting participants will be randomly assigned to the control (usual care) or intervention (CAST) arm. The intervention consists of tailored care delivery comprising in-home visits, telephone follow-up and system navigation support. The primary measure of effectiveness is mental health functioning of the older adult participant. Secondary outcomes include changes in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health and social service use and cost, from baseline to 6- and 12-months. Caregivers will be assessed for caregiver strain, depressive symptoms, anxiety, health-related quality of life, and health and social service use and costs. Descriptive and qualitative data from older adult and caregiver participants, and the nurse interventionists will be used to examine implementation of the intervention, how the intervention is adapted within each study region, and its potential for sustainability and scalability to other jurisdictions. Discussion A nurse-led transitional care strategy may provide a feasible and effective means for improving health outcomes and patient/caregiver experience and reduce service use and costs in this vulnerable population. Trial registration # NCT03157999 . Registration Date: April 4, 2017.

We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).

Objective. To validate an audio-video (AV) method of food journaling, in a free-living scenario, compared to direct, weighed food assessment. Design and Setting. Data were collected in a cafeteria. Meals, selected by participants (n=30), were documented using the AV method: participants video-recorded their tray while audio-recording a description of their selected meal, after which the research team digitally weighed each food item and created an itemized diary record of the food. Variables Measured. Data from the AV method and from the weighed food diaries were transcribed and entered into a nutrition software analysis program (Nutribase Pro 10.0). Nutrient outputs were compared between the two methods including kilocalories, macronutrients, and selected micronutrients. Analyses. Using mean scores for each variable, Wilcoxon signed-rank test and Spearman’s correlation coefficients were conducted. Interclass correlation coefficient (ICC) was calculated for absolute agreement between the two methods to assess interrater reliability. Results. With the exception of Vitamin E and total weight, nutrient values were highly correlated between methods and were statistically significant given alpha = 0.05, power = 0.95, and effect size of 0.70. Conclusions. The AV method may be a meaningful alternative to diary recording in a free-living setting.

HYPERINFLATION of the lungs impairs the function of the diaphragm by placing it at mechanical disadvantage, shortening its operating length, and changing the mechanical linkage between its various parts. These factors decrease the tension that can be developed and the amount of transdiaphragmatic pressure produced in response to a given tension. 1 2 3 4 5 Furthermore, as lung volume increases, the fraction of transdiaphragmatic pressure that can be applied to the lungs with a resultant fall in transpulmonary pressure decreases. 5 The action of the diaphragm may thus be altered in patients with chronic obstructive pulmonary disease (COPD) and may contribute to their disability and . . .

Previous studies have shown that French-speaking family physicians (FSPs) in Ontario are less numerous in areas with high proportions of francophones. The purpose of the current study was to assess whether the degree of concordance between physicians' language of competence and the linguistic profile of the community in which they practise is associated with workload and to explore variations in this relation in rural and northern regions of the province. This was a secondary analysis of the 2013 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey. We analyzed the primary practice location and language of competence of family physicians/general practitioners. We compared the practice characteristics of FSPs and non-French-speaking physicians (NFSPs) by the proportion of the francophone population, geographic location (north vs. south) and community size (urban vs. rural). Data for 10 548 family physician/general practitioners were analyzed. In areas densely populated by francophones, FSPs worked more hours per week on average and had a greater mean number of patient visits than NFSPs. Non-French-speaking physicians working in areas densely populated by francophones had fewer patient visits per hour on average than FSPs. In most cases, the results were particularly accentuated in rural and northern communities. Our findings suggest that, compared to NFSPs, the demands placed on FSPs are disproportionately greater in communities where the need for French-language health care services is greatest and the supply of FSPs is the smallest. Our results underline the importance of properly preparing family physicians to work in areas densely populated by francophones.

Many Ontarians continue to report exposure to second-hand smoke in public spaces. Completely smoke-free environments are the preferred and socially responsible option for non-smoking policies; however, when considering the variety of landscapes in which post-secondary institutions are located, 'a one size fits all' smoking policy is unrealistic to implement and enforce. The purpose of the study was to: 1) gain a better sense of the prevalence of smoking and exposure to second-hand smoke in a post-secondary context that is geographically isolated; 2) assess the awareness of existing non-smoking initiatives; and 3) identify preferred approaches for tobacco control. An online survey was distributed in 2012 to all members of the Laurentian University community. Descriptive statistics are presented, using frequency distributions, and group comparisons are reported, using Chi-Square analyses. A total of 1282 persons completed the survey. Nearly 80% of respondents reported that they had been exposed to second-hand smoke in the past month on campus and the majority of respondents felt that smoking should only be allowed in Designated Outdoor Smoking Areas (51.5%); including 37.3% of daily smokers and occasional smokers. Institutions with a geographically isolated campus, which limit options to divert smokers from public entrances, should consider the use of Designated Outdoor Smoking Areas. Implementation will create immediate reductions in the prevalence of smoking at building entrances and in high traffic locations and will therefore protect non-smokers from the dangers of environmental tobacco smoke.

Introduction. It is estimated that tobacco use kills more than 5 million people annually; it is the leading cause of preventable deaths. Recent public health interventions have likely contributed to a steady decline in rates of smoking over the past decade. Nevertheless, innovative and cost-effective approaches to smoking cessation remain a public health priority. The purpose of this study was to profile physically active smokers. Method. Data from the Canadian Community Health Survey 2007-2008–Ontario Sharing File were used. Responses from 41,800 persons aged 12 years and older were assessed to compare (a) the sociodemographic characteristics of physically active smokers to physically active nonsmokers in Ontario and (b) the types of leisure-time physical activities that are more commonly practiced among active Ontario smokers to active nonsmokers. Results. Pearson χ2 and independent samples t tests revealed that active smokers were more likely to be male, younger, single, and less educated and to have lower income than active nonsmokers. Active smokers were also more likely to report inexpensive, low-intensity, and solitary leisure-time physical activities. Conclusion. Our findings have important implications for physical activity promotion among smokers. Physical activity interventions for smokers need to be tailored differently than for nonsmokers.